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. 2005 Jun;60(6):467–473. doi: 10.1136/thx.2004.033977

Traffic related air pollution as a determinant of asthma among Taiwanese school children

B Hwang 1, Y Lee 1, Y Lin 1, J Jaakkola 1, Y Guo 1
PMCID: PMC1747433  PMID: 15923246

Abstract

Background: There is evidence that long term exposure to ambient air pollution increases the risk of childhood asthma, but the role of different sources and components needs further elaboration. To assess the effect of air pollutants on the risk of asthma among school children, a nationwide cross sectional study of 32 672 Taiwanese school children was conducted in 2001.

Methods: Routine air pollution monitoring data for sulphur dioxide (SO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO), and particles with an aerodynamic diameter of 10 µm or less (PM10) were used. Information on individual characteristics and indoor environments was from a parent administered questionnaire (response rate 93%). The exposure parameters were calculated using the mean of the 2000 monthly averages. The effect estimates were presented as odds ratios (ORs) per 10 ppb changes for SO2, NOx, and O3, 100 ppb changes for CO, and 10 µg/m3 changes for PM10.

Results: In a two stage hierarchical model adjusting for confounding, the risk of childhood asthma was positively associated with O3 (adjusted OR 1.138, 95% confidence interval (CI) 1.001 to 1.293), CO (adjusted OR 1.045, 95% CI 1.017 to 1.074), and NOx (adjusted OR 1.005, 95% CI 0.954 to 1.117). Against our prior hypothesis, the risk of childhood asthma was weakly or not related to SO2 (adjusted OR 0.874, 95% CI 0.729 to 1.054) and PM10 (adjusted OR 0.934, 95% CI 0.909 to 0.960).

Conclusions: The results are consistent with the hypothesis that long term exposure to traffic related outdoor air pollutants such as NOx, CO, and O3 increases the risk of asthma in children.

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Selected References

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  1. Asher M. I., Keil U., Anderson H. R., Beasley R., Crane J., Martinez F., Mitchell E. A., Pearce N., Sibbald B., Stewart A. W. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995 Mar;8(3):483–491. doi: 10.1183/09031936.95.08030483. [DOI] [PubMed] [Google Scholar]
  2. Bettoni Marco, Zimmermann Marc. Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation. 2002 Jun 11;105(23):2753–2759. doi: 10.1161/01.cir.0000018443.44005.d8. [DOI] [PubMed] [Google Scholar]
  3. Brauer Michael, Hoek Gerard, Van Vliet Patricia, Meliefste Kees, Fischer Paul H., Wijga Alet, Koopman Laurens P., Neijens Herman J., Gerritsen Jorrit, Kerkhof Marjan. Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. Am J Respir Crit Care Med. 2002 Oct 15;166(8):1092–1098. doi: 10.1164/rccm.200108-007OC. [DOI] [PubMed] [Google Scholar]
  4. Brunekreef Bert, Holgate Stephen T. Air pollution and health. Lancet. 2002 Oct 19;360(9341):1233–1242. doi: 10.1016/S0140-6736(02)11274-8. [DOI] [PubMed] [Google Scholar]
  5. D'Amato G. Outdoor air pollution, climate and allergic respiratory diseases: evidence of a link. Clin Exp Allergy. 2002 Oct;32(10):1391–1393. doi: 10.1046/j.1365-2745.2002.01519.x. [DOI] [PubMed] [Google Scholar]
  6. Delfino Ralph J., Gong Henry, Jr, Linn William S., Pellizzari Edo D., Hu Ye. Asthma symptoms in Hispanic children and daily ambient exposures to toxic and criteria air pollutants. Environ Health Perspect. 2003 Apr;111(4):647–656. doi: 10.1289/ehp.5992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dockery D. W., Cunningham J., Damokosh A. I., Neas L. M., Spengler J. D., Koutrakis P., Ware J. H., Raizenne M., Speizer F. E. Health effects of acid aerosols on North American children: respiratory symptoms. Environ Health Perspect. 1996 May;104(5):500–505. doi: 10.1289/ehp.96104500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dominici Francesca. Invited commentary: air pollution and health-what can we learn from a hierarchical approach? Am J Epidemiol. 2002 Jan 1;155(1):11–16. doi: 10.1093/aje/155.1.11. [DOI] [PubMed] [Google Scholar]
  9. Greenland S. Principles of multilevel modelling. Int J Epidemiol. 2000 Feb;29(1):158–167. doi: 10.1093/ije/29.1.158. [DOI] [PubMed] [Google Scholar]
  10. Guo Y. L., Lin Y. C., Sung F. C., Huang S. L., Ko Y. C., Lai J. S., Su H. J., Shaw C. K., Lin R. S., Dockery D. W. Climate, traffic-related air pollutants, and asthma prevalence in middle-school children in taiwan. Environ Health Perspect. 1999 Dec;107(12):1001–1006. doi: 10.1289/ehp.991071001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Janssen N. A., de Hartog J. J., Hoek G., Brunekreef B., Lanki T., Timonen K. L., Pekkanen J. Personal exposure to fine particulate matter in elderly subjects: relation between personal, indoor, and outdoor concentrations. J Air Waste Manag Assoc. 2000 Jul;50(7):1133–1143. doi: 10.1080/10473289.2000.10464159. [DOI] [PubMed] [Google Scholar]
  12. Janssen Nicole A. H., Schwartz Joel, Zanobetti Antonella, Suh Helen H. Air conditioning and source-specific particles as modifiers of the effect of PM(10) on hospital admissions for heart and lung disease. Environ Health Perspect. 2002 Jan;110(1):43–49. doi: 10.1289/ehp.0211043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kauffmann F., Dizier M. H., Annesi-Maesano I., Bousquet J., Charpin D., Demenais F., Ecochard D., Feingold J., Gormand F., Grimfeld A. EGEA (Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy)-- descriptive characteristics. Clin Exp Allergy. 1999 Dec;29 (Suppl 4):17–21. [PubMed] [Google Scholar]
  14. Ko Y. C. [Air pollution and its health effects on residents in Taiwanese communities]. Kaohsiung J Med Sci. 1996 Dec;12(12):657–669. [PubMed] [Google Scholar]
  15. Krämer U., Koch T., Ranft U., Ring J., Behrendt H. Traffic-related air pollution is associated with atopy in children living in urban areas. Epidemiology. 2000 Jan;11(1):64–70. doi: 10.1097/00001648-200001000-00014. [DOI] [PubMed] [Google Scholar]
  16. Laden F., Neas L. M., Dockery D. W., Schwartz J. Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environ Health Perspect. 2000 Oct;108(10):941–947. doi: 10.1289/ehp.00108941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Le Gal Grégoire, Testuz Ariane, Righini Marc, Bounameaux Henri, Perrier Arnaud. Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism. BMJ. 2005 Jan 31;330(7489):452–453. doi: 10.1136/bmj.38331.602384.8F. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lee Y. L., Shaw C. K., Su H. J., Lai J. S., Ko Y. C., Huang S. L., Sung F. C., Guo Y. L. Climate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in Taiwan. Eur Respir J. 2003 Jun;21(6):964–970. doi: 10.1183/09031936.03.00094602. [DOI] [PubMed] [Google Scholar]
  19. Lee Yung-Ling, Lin Ying-Chu, Hsiue Tzuen-Ren, Hwang Bing-Fang, Guo Yueliang Leon. Indoor and outdoor environmental exposures, parental atopy, and physician-diagnosed asthma in Taiwanese schoolchildren. Pediatrics. 2003 Nov;112(5):e389–e389. doi: 10.1542/peds.112.5.e389. [DOI] [PubMed] [Google Scholar]
  20. Matsumura Y. The effects of ozone, nitrogen dioxide, and sulfur dioxide on the experimentally induced allergic respiratory disorder in guinea pigs. I. The effect on sensitization with albumin through the airway. Am Rev Respir Dis. 1970 Sep;102(3):430–437. doi: 10.1164/arrd.1970.102.3.430. [DOI] [PubMed] [Google Scholar]
  21. McGhee S. M., Ho S. Y., Schooling M., Ho L. M., Thomas G. N., Hedley A. J., Mak K. H., Peto R., Lam T. H. Mortality associated with passive smoking in Hong Kong. BMJ. 2005 Jan 27;330(7486):287–288. doi: 10.1136/bmj.38342.706748.47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Odemuyiwa O., Malik M., Farrell T., Bashir Y., Poloniecki J., Camm J. Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. Am J Cardiol. 1991 Aug 15;68(5):434–439. doi: 10.1016/0002-9149(91)90774-f. [DOI] [PubMed] [Google Scholar]
  23. Oglesby L., Künzli N., Rösli M., Braun-Fahrländer C., Mathys P., Stern W., Jantunen M., Kousa A. Validity of ambient levels of fine particles as surrogate for personal exposure to outdoor air pollution--results of the European EXPOLIS-EAS Study (Swiss Center Basel). J Air Waste Manag Assoc. 2000 Jul;50(7):1251–1261. doi: 10.1080/10473289.2000.10464156. [DOI] [PubMed] [Google Scholar]
  24. Partti-Pellinen K., Marttila O., Ahonen A., Suominen O., Haahtela T. Penetration of nitrogen oxides and particles from outdoor into indoor air and removal of the pollutants through filtration of incoming air. Indoor Air. 2000 Jun;10(2):126–132. doi: 10.1034/j.1600-0668.2000.010002126.x. [DOI] [PubMed] [Google Scholar]
  25. Peden David B. Pollutants and asthma: role of air toxics. Environ Health Perspect. 2002 Aug;110 (Suppl 4):565–568. doi: 10.1289/ehp.110-1241207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pikhart H., Bobak M., Gorynski P., Wojtyniak B., Danova J., Celko M. A., Kriz B., Briggs D., Elliott P. Outdoor sulphur dioxide and respiratory symptoms in Czech and Polish school children: a small-area study (SAVIAH). Small-Area Variation in Air Pollution and Health. Int Arch Occup Environ Health. 2001 Oct;74(8):574–578. doi: 10.1007/s004200100266. [DOI] [PubMed] [Google Scholar]
  27. Pope C. A., 3rd, Verrier R. L., Lovett E. G., Larson A. C., Raizenne M. E., Kanner R. E., Schwartz J., Villegas G. M., Gold D. R., Dockery D. W. Heart rate variability associated with particulate air pollution. Am Heart J. 1999 Nov;138(5 Pt 1):890–899. doi: 10.1016/s0002-8703(99)70014-1. [DOI] [PubMed] [Google Scholar]
  28. Ramirez-Aguilar Matiana, Cicero-Fernandez Pablo, Winer Arthur M., Romieu Isabelle, Meneses-Gonzalez Fernando, Hernandez-Avila Mauricio. Measurements of personal exposure to nitrogen dioxide in four Mexican cities in 1996. J Air Waste Manag Assoc. 2002 Jan;52(1):50–57. doi: 10.1080/10473289.2002.10470761. [DOI] [PubMed] [Google Scholar]
  29. Rojas-Bracho Leonora, Suh Helen H., Oyola Pedro, Koutrakis Petros. Measurements of children's exposures to particles and nitrogen dioxide in Santiago, Chile. Sci Total Environ. 2002 Mar 27;287(3):249–264. doi: 10.1016/s0048-9697(01)00987-1. [DOI] [PubMed] [Google Scholar]
  30. Ross Mary A., Persky Victoria W., Scheff Peter A., Chung Joseph, Curtis Luke, Ramakrishnan Viswanathan, Wadden Richard A., Hryhorczuk Daniel O. Effect of ozone and aeroallergens on the respiratory health of asthmatics. Arch Environ Health. 2002 Nov-Dec;57(6):568–578. doi: 10.1080/00039890209602090. [DOI] [PubMed] [Google Scholar]
  31. Sarnat J. A., Koutrakis P., Suh H. H. Assessing the relationship between personal particulate and gaseous exposures of senior citizens living in Baltimore, MD. J Air Waste Manag Assoc. 2000 Jul;50(7):1184–1198. doi: 10.1080/10473289.2000.10464165. [DOI] [PubMed] [Google Scholar]
  32. Sarnat J. A., Schwartz J., Catalano P. J., Suh H. H. Gaseous pollutants in particulate matter epidemiology: confounders or surrogates? Environ Health Perspect. 2001 Oct;109(10):1053–1061. doi: 10.1289/ehp.011091053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Selman David. Scopolamine? J Am Coll Cardiol. 2002 Feb 20;39(4):744–745. [PubMed] [Google Scholar]
  34. Shima M., Adachi M. Effect of outdoor and indoor nitrogen dioxide on respiratory symptoms in schoolchildren. Int J Epidemiol. 2000 Oct;29(5):862–870. doi: 10.1093/ije/29.5.862. [DOI] [PubMed] [Google Scholar]
  35. Studnicka M., Hackl E., Pischinger J., Fangmeyer C., Haschke N., Kühr J., Urbanek R., Neumann M., Frischer T. Traffic-related NO2 and the prevalence of asthma and respiratory symptoms in seven year olds. Eur Respir J. 1997 Oct;10(10):2275–2278. doi: 10.1183/09031936.97.10102275. [DOI] [PubMed] [Google Scholar]
  36. Tsuji H., Larson M. G., Venditti F. J., Jr, Manders E. S., Evans J. C., Feldman C. L., Levy D. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation. 1996 Dec 1;94(11):2850–2855. doi: 10.1161/01.cir.94.11.2850. [DOI] [PubMed] [Google Scholar]
  37. Vineis P., Airoldi L., Veglia F., Olgiati L., Pastorelli R., Autrup H., Dunning A., Garte S., Gormally E., Hainaut P. Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study. BMJ. 2005 Jan 28;330(7486):277–277. doi: 10.1136/bmj.38327.648472.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wang J. H., Devalia J. L., Duddle J. M., Hamilton S. A., Davies R. J. Effect of six-hour exposure to nitrogen dioxide on early-phase nasal response to allergen challenge in patients with a history of seasonal allergic rhinitis. J Allergy Clin Immunol. 1995 Nov;96(5 Pt 1):669–676. doi: 10.1016/s0091-6749(95)70266-0. [DOI] [PubMed] [Google Scholar]
  39. Witte J. S., Greenland S., Kim L. L., Arab L. Multilevel modeling in epidemiology with GLIMMIX. Epidemiology. 2000 Nov;11(6):684–688. doi: 10.1097/00001648-200011000-00012. [DOI] [PubMed] [Google Scholar]
  40. Yu O., Sheppard L., Lumley T., Koenig J. Q., Shapiro G. G. Effects of ambient air pollution on symptoms of asthma in Seattle-area children enrolled in the CAMP study. Environ Health Perspect. 2000 Dec;108(12):1209–1214. doi: 10.1289/ehp.001081209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Zanobetti A., Schwartz J., Gold D. Are there sensitive subgroups for the effects of airborne particles? Environ Health Perspect. 2000 Sep;108(9):841–845. doi: 10.1289/ehp.00108841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zhang Junfeng Jim, Hu Wei, Wei Fusheng, Wu Guoping, Korn Leo R., Chapman Robert S. Children's respiratory morbidity prevalence in relation to air pollution in four Chinese cities. Environ Health Perspect. 2002 Sep;110(9):961–967. doi: 10.1289/ehp.02110961. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. von Mutius E., Martinez F. D., Fritzsch C., Nicolai T., Roell G., Thiemann H. H. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):358–364. doi: 10.1164/ajrccm.149.2.8306030. [DOI] [PubMed] [Google Scholar]

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